1720842065 NPI number — ANN ENTRUP-HERRMANN MA ART THERAPY

Table of content: ANN ENTRUP-HERRMANN MA ART THERAPY (NPI 1720842065)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1720842065 NPI number — ANN ENTRUP-HERRMANN MA ART THERAPY

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
ENTRUP-HERRMANN
Provider First Name:
ANN
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
MA ART THERAPY
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1720842065
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
02/07/2024
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
VA BLACK HILLS HEALTH CARE
Provider Second Line Business Mailing Address:
113 COMANCHE ROAD
Provider Business Mailing Address City Name:
FORT MEADE
Provider Business Mailing Address State Name:
SD
Provider Business Mailing Address Postal Code:
57741
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
605-347-2511
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
VA BLACK HILLS HEALTH CARE
Provider Second Line Business Practice Location Address:
113 COMANCHE ROAD
Provider Business Practice Location Address City Name:
FORT MEADE
Provider Business Practice Location Address State Name:
SD
Provider Business Practice Location Address Postal Code:
57741
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
605-347-2511
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
02/07/2024

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 221700000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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